3DTEE as an alternative approach for the evaluation of aortic valve complex in CKD post renal transplant patient for transcatheter aortic valve implantation (TAVI)

Transcatheter aortic valve implantation (TAVI) is an innovative and less invasive treatment for most of the population with severe aortic stenosis (AS). Now a days TAVI has been included as class I indication in ACC guidelines for patient subset >65 years of age. Few of the patients among these have chronic kidney disease and required regular dialysis for the same. Such patient could not tolerate high volume contrast injection during Pre TAVI aortic valve assessment. We present a case of post renal transplant, CKD stage IV patient with severe calcific aortic stenosis. We have done pre TAVI aortic valve assessment via 3D TEE (Trans esophageal echocardiography) only to avoid high volume contrast injection. 3D TEE assessment for aortic annulus, aortic annulus to left main coronary ostium height, aortic annulus to right coronary ostium height, aortic valve area. All such parameters were derived by 3D TEE and procedure was successful with no procedural complications, annular prosthesis mismatch and no paravalvular leakage.